How to inject Saxenda

Key points

• 01This is a daily injection, which changes the whole routine. Liraglutide for weight management is injected once daily rather than once weekly. That means seven times the needles, seven times the sharps volume and seven times the site rotation pressure compared with a weekly GLP-1. Everything about supply planning and rotation follows from that one fact.
• 02Time of day is flexible, consistency is not. The label describes injecting once daily at any time of day, without regard to meals. What matters is picking a time you can reliably keep, because a daily medication is missed far more often through drift than through decision. Tie it to an existing anchor rather than to intention.
• 03The escalation is weekly, in 0.6 mg steps. The label sets out 0.6 mg in week one, 1.2 mg in week two, 1.8 mg in week three, 2.4 mg in week four and 3 mg from week five onward. The steps exist to reduce gastrointestinal side effects, and the label describes the 3 mg daily dose as the recommended maintenance dose for adults.
• 04The pen is dialable, so the counter is a safety step. Unlike the fixed weekly pens, this device delivers different doses from the same cartridge. That flexibility is also a failure mode: the counter must be read at every injection, not assumed. Our post on checking dose math before injecting covers how to build that read into the routine.
• 05The three sites, and why they run out faster here. The abdomen, the front of the thigh and the upper arm are the subcutaneous sites named in the label. With a daily injection, a lazy rotation puts you back in the same square inch within a week, which the injection-technique literature associates with hardened tissue and unpredictable absorption.
• 06A rotation that survives a daily schedule. Divide each site into quadrants, move at least a finger width from the previous puncture, and change quadrant on a fixed day. Our rotating injection sites guide has a pattern you can follow without thinking, which is the only kind that survives a daily medication.
• 07The flow check is once per pen, not once per dose. New pen, one flow check. Every subsequent injection from that pen is dial and inject. People who repeat the flow check daily waste medication and shorten the pen, and people who skip it on a new pen risk injecting air on the first dose from that cartridge.
• 08A new needle every time, and never stored on the pen. A reused needle is blunter and less sterile, and a needle left on the pen lets air into the cartridge and can cause leaking that affects the next dose. At seven doses a week this adds up, so make sure pen needles are actually on your prescription in sufficient quantity.
• 09A missed dose is not made up, and a long gap restarts the ramp. The label says to resume the once-daily regimen with the next scheduled dose and not to take an extra dose or increase the dose to compensate. It also describes reinitiating at 0.6 mg daily and following the escalation again if more than three days have elapsed since the last dose.
• 10Storage before and after first use. Refrigerate an unused pen and check the leaflet for the in-use period, which on this pen family is about 30 days either refrigerated or below 86 F, meaning 30 C, with the cap on and no needle attached. Write the date of first use on the pen, because a daily pen empties before you expect.
• 11The sharps container is a weekly consideration, not a yearly one. Seven needles a week fills a small container quickly. Size the container to your actual rate and know where the full one goes before you need to answer that question. Our sharps container guide covers sizing, and the disposal guide covers the local routes.
• 12Log the site, not just the dose. With a daily injection the site column is the one that earns its keep, because rotation only exists if it is recorded. A card taped inside a cupboard door beside where you inject beats an app you have to unlock, and it answers the did I inject today question in one second.

Pre-injection checklist

• ✓Keep the instructions for use that came with your pen. Saxenda is a once-daily injection and that leaflet is the governing source for every device step below.
• ✓Check the name, the expiry date and the liquid through the window. It should be clear and colourless. Do not use a pen whose solution is cloudy, discoloured or contains particles.
• ✓Let a refrigerated pen warm toward room temperature before injecting, since cold injections are associated with more stinging in patient-education literature.
• ✓Choose a site and rotate it. Because this medication is daily, sites are used up much faster than with a weekly injection.
• ✓This is a technique reference, not medical advice. Your dose and the escalation are set by your prescriber.

Step-by-step guide

1. 1

   Wash your hands and set up

   Wash with soap and water for at least 20 seconds and dry on a clean towel. Lay out the pen, a new needle, an alcohol pad and gauze on a clean surface, and open the sharps container before you start so the used needle has somewhere to go the moment it comes off.

   Pro tip

   Always check the fluid is clear and colourless before injection.
2. 2

   Check the pen and the solution

   Read the label to confirm it is your medication and check the expiry date. Look at the liquid through the window: it should be clear and colourless. A pen that has frozen, or whose solution looks cloudy or discoloured, is not used. Call the pharmacy rather than injecting and hoping.

   Pro tip

   Always check the fluid is clear and colourless before injection.
3. 3

   Attach a new needle

   Pull the paper tab off a new needle, push it straight onto the pen and screw it on. Take off the outer cap and keep it, since it is what you will use to remove the needle afterwards. Take off the inner cap and drop it in the bin. A new needle is used for every single injection.

   Pro tip

   Always check the fluid is clear and colourless before injection.
4. 4

   Do the flow check on a new pen

   The first time you use a new pen, set the dose selector to the flow-check symbol, hold the pen with the needle pointing up, and press the dose button until a drop appears at the tip. Repeat if nothing appears. This confirms the pen delivers medication rather than air, and it is done once per pen.

   Pro tip

   Always check the fluid is clear and colourless before injection.
5. 5

   Dial your prescribed dose

   Turn the dose selector until your prescribed dose lines up with the pointer, and read the counter rather than counting clicks. If you overshoot, turn back. The pen is dialable, which is exactly why the counter must be read before every injection rather than assumed from yesterday.

   Pro tip

   Always check the fluid is clear and colourless before injection.
6. 6

   Choose and clean the site

   Pick from the abdomen, the front of the thigh or the upper arm, and choose a spot you have not used in the last several days. Wipe it with the alcohol pad and let it air-dry for at least ten to fifteen seconds. Injecting through wet alcohol is the most common avoidable cause of stinging.

   Pro tip

   Always check the fluid is clear and colourless before injection.
7. 7

   Insert the needle

   Insert the needle into the subcutaneous fat the way you were shown, which with a short pen needle is usually straight in at 90 degrees. Pinch a fold of skin if your technique calls for one. Keep your thumb ready on the dose button and your grip steady so the pen does not shift.

   Pro tip

   Always check the fluid is clear and colourless before injection.
8. 8

   Press and hold until the counter reads zero

   Press the dose button all the way in and hold it while you watch the counter come down. The counter reaching 0 is the signal that the dose has been delivered, not the sound of the pen or the feel of the button. Do not tilt the pen while the counter is moving.

   Pro tip

   Always check the fluid is clear and colourless before injection.
9. 9

   Hold for the count in your instructions

   With the counter at 0, keep the needle in the skin and the button pressed for the number of seconds your instructions for use specifies. On the Novo Nordisk pens in this family that is a slow count of 6. Lifting early is the most common way part of a dose is left behind.

   Pro tip

   Always check the fluid is clear and colourless before injection.
10. 10

    Withdraw and remove the needle

    Pull the needle straight out along the line it went in. Guide the outer cap back over the needle, unscrew it, and drop it into the sharps container. Store the pen with its cap on and no needle attached, because a needle left on lets air into the cartridge and can cause leaking.

    Pro tip

    Always check the fluid is clear and colourless before injection.

After the injection

• Press a clean cotton ball or gauze square to the site for a few seconds if it bleeds, without rubbing.
• Record the date, the dose and the site. With a daily injection the site record is what makes rotation real.
• Store the pen with the cap on and no needle attached, and keep it out of reach of children and pets.
• Leave the site alone afterwards. No massage and no hot shower straight away, since heat and rubbing can change absorption.

Common mistakes

Frequently asked questions

Sources

1. Novo Nordisk. Saxenda (liraglutide) Prescribing Information, DailyMed listing.
2. Novo Nordisk. Saxenda (liraglutide) prescribing information and instructions for use.
3. European Medicines Agency. Saxenda (liraglutide) Summary of Product Characteristics.
4. Frid AH et al. 2016. New Insulin Delivery Recommendations. Mayo Clinic Proceedings 91(9):1231-1255.
5. MedlinePlus. Giving a subcutaneous injection (patient instructions).